• accuracy
• expertise
• face
• head
• intention
• kick
• perception

• Social structure
• health equity
• intersectional framework
• life course perspective
• social determinants of health

• Humans
• Pain/psychology
• Social Determinants of Health
• Interpersonal Relations

• K01 DA045735 NIDA NIH HHS

• gender differences
• pain encoding
• nonverbal communication
• merged dataset
• experimental pain
• facial expression of pain

• Humans
• Female
• Male
• Facial Expression
• Sex Characteristics
• Adult
• Pain/psychology
• Pain/physiopathology
• Pain Measurement/methods
• Young Adult
• Pain Threshold/physiology
• Middle Aged
• Adolescent

• HO 5573/1-1 Deutsche Forschungsgemeinschaft

• Catastrophizing
• Orofacial Pain
• Pain Perception

• Humans
• Male
• Female
• Cross-Sectional Studies
• Pupil/physiology
• Pain Measurement
• Adult
• Pain Perception/physiology
• Cognition/physiology
• Young Adult

• pain and culture
• pain behavior
• pain expression
• pain response
• stoic response
• surgical pain

• Funding

• Adult
• Humans
• Female
• Hyperalgesia
• Pain
• Skin
• Electric Stimulation
• Social Support

• interracial interactions
• social modulation of pain
• race
• ethnicity
• chronic pain

• Humans
• Pain
• Physician-Patient Relations

• T32 DA035165 NIDA NIH HHS

• Electrical stimulation
• Healthy volunteers
• Mechanical hyperalgesia
• Pain
• Secondary hyperalgesia
• Threat

• Fos
• Pain
• Pain matrix
• Social stress

• 360° videos
• empathy
• pain
• patient-physician relationship
• psychology

Social context such as the relationship between a person experiencing pain and a caregiver has been shown to affect the experience of pain, yet, results are not consistent. Possibly, differential effects of interpersonal relationships are modulated by affective states expressed by social partners. Viewing partner pictures in experimental designs is not only associated with lowered perceived pain intensity, but also affects neural responses. However, the role of affective modulation is not clear. The present study aimed to systematically examine the pain modulating effects of stimuli varying in affect and social content including personal relevance using subjective report and psychophysiological measures of facial and autonomic activity.

Twenty-nine women underwent a tonic heat pain paradigm with simultaneous picture viewing to investigate the influence of their partners’ faces with a neutral facial expression compared to strangers’ happy, angry and neutral facial expressions on pain intensity and accompanying psychophysiological parameters (facial activity: corrugator muscle activity, autonomic activity: skin conductance level, heart rate). In addition to perceived partner support and relationship characteristics, the contribution of the affective value (valence, arousal) of the partner faces to the observed pain modulation was examined.

Partner and happy faces reduced self-reported pain intensity and corrugator activity, the latter being lowest when viewing partner faces as compared to all other picture categories. As corrugator activity is indexing stimulus unpleasantness and a core feature of the facial pain expression, this physiological pattern matches well with the subjective ratings. Neutral objects, neutral and angry faces had no effect on pain self-report, although angry faces were rated as highly negative. Partner faces also led to increased skin conductance, being an index of motivational activation, and heart rate deceleration, possibly reflecting increased sensory intake. Partner-related pain modulation was primarily related to perceived arousal of the partner’s picture, i.e., the intensity of the activation of approach motivation, and pain-related catastrophizing.

Our results are partially consistent with emotional pain control models, especially regarding the modulatory influence of valence. Within the context of socially adaptive behavior, they particularly underline the social signal value of emotion and attachment figures. Clinically, our results imply that just looking at pictures of one’s partner when undergoing acute painful procedures can have a robust hypoalgesic effect.

• Adult
• Emotions
• Facial Expression
• Female
• Humans
• Interpersonal Relations
• Male
• Models, Psychological
• Pain/psychology

• . Stress
• Chronic Pain
• Focus Group
• NUTS
• Pain Appraisal
• Qualitative

• neuroscience
• empathy

Maladaptive defensive responses such as excessive avoidance behavior have received increasing attention as a main mechanism for the development and maintenance of chronic pain complaints. However, another defensive response which is commonly studied in animals as a proxy for fear is freezing behavior. No research to date has investigated human freezing behavior in the context of pain. In addition, there is an increasing realization that social context can affect pain-relevant processes such as pain experience and pain behavior but less is known about the effects of social context on defensive responses to pain. Hence, this study investigated freezing behavior and facial pain expression in the context of pain, and their modulation by social context.

Healthy, pain-free participants (N = 39) stood on a stabilometric force platform in a threatening or safe social context, which was manipulated using angry or happy facial stimuli. In some trials, an auditory cue (conditioned stimulus; CS) predicted the occurrence of painful electrocutaneous stimulus (unconditioned stimulus; pain-US). We assessed body sway (an index of freezing), heart rate, facial pain expression, self-reported pain intensity, unpleasantness, and pain-US expectancy during the CS and the context alone (no CS).

The results were mixed. Neither the anticipation of pain, nor social context affected body sway. Heart rate and painful facial expression were reduced in the threatening social context at high anxiety levels. A threatening social context also elicited higher pain-US expectancy ratings. In sum, a threatening social context increases the expectation of pain, but reduces the facial expression of pain and lowers heart rate in highly anxious individuals.

• Body sway
• Expectancy
• Fear conditioning
• Freezing
• Heart rate
• Pain
• Pain expression
• Social context
• Social threat

Pain scales are tools developed to improve pain assessment in horses. They are based on behaviors and/or facial expressions, and the observer allocates a score based on the character of the behavior or facial expression. Little is known about behaviors and facial expressions at rest in horses with orthopedic pain since pain is mainly assessed by lameness evaluation during movement. The aim of this study was to describe how closely equine behaviors and facial expressions are associated with movement asymmetry and to identify combinations of behavior and expressions present in horses with induced orthopedic pain. Orthopedic pain was induced in eight horses and assessed in two ways; using four existing equine pain scales at rest, and by measuring movement asymmetry during movement. The association of behavior and facial expression items in the pain scales with actual lameness was analyzed. Posture-related behavior showed the strongest association, while facial expressions varied between horses. These results show that pain scales for orthopedic pain assessment would benefit from including posture, head position, location in the box stall, focus, interactive behavior, and facial expressions. This could improve orthopedic pain detection in horses during rest with mild lameness.

Equine orthopedic pain scales are targeted towards horses with moderate to severe orthopedic pain. Improved assessment of pain behavior and pain-related facial expressions at rest may refine orthopedic pain detection for mild lameness grades. Therefore, this study explored pain-related behaviors and facial expressions and sought to identify frequently occurring combinations. Orthopedic pain was induced by intra-articular LPS in eight horses, and objective movement asymmetry analyses were performed before and after induction together with pain assessments at rest. Three observers independently assessed horses in their box stalls, using four equine pain scales simultaneously. Increase in movement asymmetry after induction was used as a proxy for pain. Behaviors and facial expressions commonly co-occurred and were strongly associated with movement asymmetry. Posture-related scale items were the strongest predictors of movement asymmetry. Display of facial expressions at rest varied between horses but, when present, were strongly associated with movement asymmetry. Reliability of facial expression items was lower than reliability of behavioral items. These findings suggest that five body behaviors (posture, head position, location in the box stall, focus, and interactive behavior) should be included in a scale for live assessment of mild orthopedic pain. We also recommend inclusion of facial expressions in pain assessment.

• horses
• lameness
• movement asymmetry
• movement symmetry
• pain indicator
• pain predictor
• reliability

Despite the growing interest on the effect of the social context on pain, whether and how different facets of interpersonal interactions modulate pain are still unclear. We tested whether personal (i.e., convenient for the self), moral (i.e., equitability of the transaction) or social (i.e., positive vs. negative feedback from others) valence of an interpersonal interaction differentially affects pain and the perceived fairness. Thirty-two healthy participants played the role of Receivers in a Dictator Game, where a player, the Dictator, determined how to divide a payoff between her/himself and the other player, the Receiver. We manipulated the payoff (pain vs. money), the personal valence (favorable vs. unfavorable offer to participants), the moral valence of the offer (from very iniquitous to equitable), and social valence of the Dictator (social acceptance vs. rejection). Moral and personal valence differentially modulated pain. Lower pain was elicited by iniquity, but also by favorable offers. Moreover, unfavorable offers in the economic game were rated as more unfair, whereas only very iniquitous offers elicited such ratings in the pain game, suggesting that participants valued when Dictators endured extra pain for their benefit. Together, we show that the valence of a social interaction at different levels can independently modulate pain and fairness perception.

• evolutionary psychology
• pain facial expression
• social context

• Social threat
• aggression
• communication
• empathy
• pain expression
• retribution
• self-report

• Adolescent
• Adult
• Aggression/physiology
• Communication
• Electric Stimulation
• Empathy/physiology
• Facial Expression
• Fear/physiology
• Female
• Humans
• Interpersonal Relations
• Nociceptive Pain/physiopathology
• Pain Measurement
• Pain Perception/physiology
• Self Report
• Social Perception
• Touch Perception/physiology
• Young Adult

• partner loss
• pain
• anxiety
• social modulation
• prairie vole

• Chronic low back pain
• automatic emotion recognition
• body movement
• emotion
• facial expression
• motion capture
• multimodal database
• pain behaviour
• surface electromyography

• G0700729 Medical Research Council
• P30 AG022845 NIA NIH HHS

In this review article, we describe a social-signaling perspective of human pain and pain empathizing behaviors which is based on the premise that pain percepts evolved to serve both intrapersonal as well as interpersonal, communicative functions. This perspective offers a generative framework for understanding the natural origin and proximate expression of felt pain and pain empathizing behaviors. The basic thesis is that humans evolved sensory-behavioral heuristics for perceiving and inhibiting exogenous and endogenous pain sensations as part of more general expressive styles characterized by the demonstration of vulnerability gestures (i.e., trustworthiness cues) versus empowerment gestures (i.e., capacity cues), and these styles ultimately facilitate broader self-protection and social novelty-seeking life-history behavior strategies, respectively. We review the extant literature on how social contextual factors (e.g., audience characteristics) and how structural and functional components of individual’s social network appear to influence the expression of pain behaviors in ways that support basic predictions from the social-signaling perspective. We also show how the perspective can be used to interpret conventional findings of sex differences in pain percepts and pain empathizing behaviors and for predicting how the situational context and individual’s peer networks modulate these differences in vitro and in vitro. We conclude the article by describing how pain researchers may better understand how varying levels and divergent directions of changes in affect tend to co-occur with systematic changes in internal vs external pain sensitivities, and thus why, from an evolutionary perspective, pain may occur in the presence and absence of physical tissue damage.

• Pain behaviors
• Psychology
• Social support
• Sex differences
• Communication

• attachment
• empathy
• pain
• predictive coding
• review
• social modulation
• social support

Because pain signals potential harm to the organism, it immediately attracts attention and motivates decisions and action. However, pain is also subject to motivations—an aspect that has led to considerable changes in our understanding of (chronic) pain over the recent years. The relationship between pain and motivational states is therefore clearly bidirectional. This review provides an overview on behavioral and neuroimaging studies investigating motivational aspects of pain. We highlight recent insights into the modulation of pain through fear and social factors, summarize findings on the role of pain in fear conditioning, avoidance learning and goal conflicts and discuss evidence on pain-related cognitive interference and motivational aspects of pain relief.

• affective
• analgesia
• cognitive
• goals
• learning
• modulation
• motivation
• pain